Engaging junior doctors with the NHS: Qualitative research
Summary of findings
The sources of trusted information changed during the course of junior doctors’ training period. The most trusted sources at each stage of training tended to be the individuals and/or organisations with which junior doctors had most frequent contact. Trusted sources were as follows: • For medical students, their medical school and the BMA/BMJ • For foundation doctors, their deaneries and clinical supervisors • For those in specialist training, their hospital trust/PCT and their particular professional bodies. Face to face communication was generally preferred, although online contact was also acknowledged as quick and efficient. In this context, use of a mix of face to face and online channels was considered to be the best means of communicating with junior doctors. Junior doctors and local Medical Directors were theoretically positive about the NHS Medical Director post being used to help develop and direct engagement with junior doctors and endorsed DH as a natural banner under which the NHS Medical Director should sit. Junior doctors and local Medical Directors reported having limited contact with each other. However, all parties expressed an interest in having more contact in the future. Not all research participants were aware of the Agents for Change programme but, once explained, there was a consensus that this type of activity can be effective in engaging junior doctors and providing channels of communication between junior doctors and more senior management. Junior doctors tended not to be interacting directly with DH. However, all felt that it would be beneficial to both DH and junior doctors if DH began to communicate with them directly and consistently about national/policy initiatives affecting the NHS. Junior doctors felt that DH was the natural and expected source of this type of information. Having said this, junior doctors also felt it to be critical that DH acts to develop its relationship with junior doctors so that the latter believe that future engagement will be worthwhile. Wherever possible, the focus should be on two way communication between junior doctors and DH/NHS managers. Given that the level of trust and engagement with an information source increases if the provider is known and familiar, the Department should look for as many opportunities as possible for direct, face to face contact between junior doctors and NHS managers of all levels, from national through to local. Other trusted bodies/intermediaries (such as medical schools, deaneries, trusts and professional associations) were felt to provide a useful means of raising awareness of the existence and relevance of DH information about national/policy initiatives affecting the NHS. However, if the relationship between junior doctors and DH is to be improved, it was felt to be critical that DH provides information direct, rather than delegating responsibility for this to others. Junior doctors strongly endorsed the idea of DH providing a direct e-channel for junior doctors but highlighted that this channel would only succeed if DH worked to develop and strengthen its relationship with junior doctors. The key elements of an effective engagement approach for junior doctors can be summarised as follows: 1. Establish a branding and communication framework that joins up national, regional and local hierarchies • Enabling two way communication between all parties • Specifically facilitating junior doctors to feed up their ideas • Allowing junior doctors to have anonymity if they wish 2. Establish the NHS Medical Director as a figurehead for DH and policy matters: • Supported by a high profile team of junior doctor representatives (selected across levels of experience/specialty) • Using his role to inspire junior doctors to get involved in shaping change • Using his role to create buy in, and facilitate joined up communication, at national, regional and local levels 3. Establish local Medical Directors as local figureheads so that they have more face to face contact with junior doctors, encouraging them to: • Manifest this contact via inductions, Quality & Efficiency or policy meetings and/or conferences • Develop communication structures that allow for quick and easy communication of ideas and issues in a responsive environment • Reward junior doctors’ ideas and achievements publicly • Influence medical school curricula where possible to expose medical students to policy issues early on 4. Establish a junior doctor Agents for Change programme under the DH banner that joins up local, regional and national activity relating to policy and the quality and efficiency agenda, within this: • Positioning the programme as emanating from and being embedded in front line practice • Developing and bringing together opportunities to get involved in management and leadership (such as courses, secondment opportunities and placements in DH and other bodies) • Focusing on discussion of topics such as the role of junior doctors, their training needs and ideas for service improvement • Using the programme to spread good practice • Encouraging the participation of junior doctor representatives • Ensuring that channels of communication are in place to aid the flow of communication between national and local levels • Focusing on publication of achievements and/or Agents for Change awards as a reward for participation 5. Act to increase junior doctors’ identification and empathy with management by encouraging more face to face contact between the parties at key points within junior doctor training 6. Integrate into junior doctors’ training programmes inductions that involve interaction with local Medical Directors and provide information on DH/NHS and the structures in place that enable junior doctors to effect change 7. Raise awareness of and promote these initiatives on an ongoing basis.
The overall aim of the research was to understand how to engage junior doctors more effectively with policy concerning the NHS, in the specific context of the quality and efficiency agenda. Within this, there was a requirement to understand barriers to engagement, how these can be addressed and to identify the channels for successfully engaging this audience going forward.
The NHS needs to make substantial efficiency savings in the period 2011-14 and the involvement of junior doctors is crucial to help achieve this. However, this audience can be difficult to reach and engage in policy initiatives
The research suggested that junior doctors were open to the idea of more two-way dialogue between themselves and DH/NHS managers; the NHS Medical Director and local Medical Directors could play an important role in this
A mixed method was adopted: • 20 x 1 hour face to face paired depth interviews amongst junior doctors • 5 x 45 minute face to face and telephone depth interviews amongst local Medical Directors. Paired depth interviews were used for interviewing junior doctors because they combined the benefits of: • Allowing for a degree of cross-fertilisation of ideas but within a supportive environment • Facilitating the exploration of detailed understanding, views and preferences regarding a wide range of complex issues • Making it more feasible to recruit participants on the basis of precise criteria, such as years of training or specialty. Depth interviews were chosen as the most practical method for interviewing local Medical Directors, given the time pressured nature of the working practices of this group and the fact that they are geographically widespread.
Data collection methodology
Junior doctors n=c.40, Local medical directors n=5 The sample of junior doctors comprised a spread of levels of experience below Consultant grade
Interviews were conducted in Birmingham, Bristol, Cheshire and London
10th January - 31st March 2010